同性戀螺桿菌感染引起之菌血症－一個被忽略的愛滋病患發燒病因

Bacteremia Caused by Helicobacter Cinaedi–A Neglected Etiology of Fever in an HIV Patient

同性戀螺桿菌（Helicobacter cinaedi）為肝腸螺桿菌屬（enterohepatic Helicobacter species），好發於男同性戀者或免疫缺陷患者，其中菌血症常因常規培養的時間不足而被忽略。病例是一個28歲的男性同性戀愛滋病及右側小腦瀰漫性巨大B細胞淋巴瘤患者，於住院化療時出現發燒的現象，但並無其他臨床症狀。血液培養瓶為陽性，且抹片呈革蘭氏陰性螺桿菌的形態。再利用質譜儀及核酸序列的比對，鑑定為同性戀螺桿菌。在血液培養鑑定報告出來之前所使用的抗生素有cefuroxime和肺囊蟲肺炎的次級預防抗生素trimethoprim-sulfamethoxazole。此同性戀螺桿菌的藥物敏感性試驗對於這兩種抗生素皆呈現抗藥性，但病人的臨床狀況改善，且在追蹤的血液培養也呈陰性後順利出院。希望藉由此次成功培養與鑑定同性戀螺桿菌的經驗與同業分享。

Helicobacter cinaedi is an enterohepatic Helicobacter species that commonly occurred in immunocompromised patients, where bacteremia is often overlooked due to insufficient time for routine culture. The case was a 28-year-old male homosexual AIDS patient with diffuse large B-Cell lymphoma at right cerebellum who developed fever during hospitalization, but had no other clinical symptoms. The blood culture showed positive result, and the smear appear the form of Gram-negative Helicobacter. The mass spectrometer and the nucleic acid sequence were used to further confirmation. The bacterium was identified as Helicobacter cinaedi. The antibiotic used before the blood culture test reporting were cefuroxime and the secondary preventive antibiotic, trimethoprim-sulfamethoxazole, which used in pneumocystic pneumonia. Although the isolated Helicobacter cinaedi was found to be resistant to cefuroxime and trimethoprim-sulfamethoxazol, the patient's clinical condition improved and he was discharged after the blood culture was also negative. Hopefully, this experience could provide the peers laboratories of microbiology some information of culture and identification of Helicobacter cinaedi in clinical practice.